深在性囊性胃炎及并发肿瘤性病变的初步临床诊治特点

Characteristics of preliminary clinical diagnosis and treatment for gastritis cystica profunda accompanied with neoplastic lesions

目的探讨深在性囊性胃炎(gastritis cystica profunda,GCP)及合并肿瘤性病变的临床特点、白光内镜和超声内镜下特征性表现及治疗情况。方法回顾性收集首都医科大学附属北京友谊医院消化分中心2015年1月—2021年2月经内镜或手术治疗后病理确诊为GCP的35例(合并肿瘤性病变27例)患者临床资料,总结GCP的人群构成、临床表现、内镜下特征、治疗方法、病理结果等情况。结果纳入的35例GCP患者,年龄(68.26±8.08)岁,男性多见(80.00%,28/35),最常见症状为上腹部疼痛,占31.43%(11/35),无症状占25.71%(9/35),其他症状包括反酸烧心、腹胀、贫血、进食哽咽感等。GCP好发部位为贲门(51.43%,18/35),在内镜检查时主要表现为黏膜平坦型病变(68.57%,24/35),以0‑Ⅱa及0‑Ⅱa+Ⅱc型病灶为主,占66.67%(16/24),其次为息肉样隆起(20.00%,7/35)。术前15例行超声内镜检查,主要表现为均匀低回声伴或不伴囊性回声(73.33%,11/15)。纳入的GCP病例中行内镜下手术治疗33例,外科手术治疗2例,治疗过程均顺利完成,其中内镜治疗病灶均整块切除,平均内镜手术时间86.13 min。1例患者行内镜黏膜下剥离术后出现迟发性出血。术后病理显示GCP并发肿瘤性病变比例为77.14%(27/35),GCP合并早期胃癌及癌前病变比例为68.57%(24/35),其中23例为R0切除,另1例基底切缘未净并脉管侵犯,术后5个月原位复发,追加外科手术,内镜完整切除率达95.83%(23/24)。结论GCP好发于中老年男性,好发于贲门,内镜主要表现为黏膜平坦型病变及息肉样改变,术前超声内镜对发现GCP有较高的诊断价值,内镜下治疗GCP是安全、有效的微创治疗方式。

Objective To investigate the clinical features,characteristics under white‑light endoscopy and endoscopic ultrasonography,and treatment strategies of gastritis cystica profunda(GCP)accompanied with or without neoplastic lesions.Methods Clinical data of 35 patients,who were pathologically diagnosed as having GCP after endoscopic or surgical resection in Beijing Friendship Hospital,Capital Medical University from January 2015 to February 2021,were retrospectively collected,including 27 patients with neoplastic lesions.The demographic information,clinical manifestations,endoscopic features,treatment methods,and pathological results of GCP were summarized.Results Thirty‑five patients with GCP were 68.26±8.08 years old,and mostly male(80.00%,28/35).The most common symptom was upper abdominal pain,accounting for 31.43%(11/35),and 25.71%(9/35)had no symptoms.Other symptoms included acid reflux,heartburn,abdominal distension,anemia,and choking sensation after eating.The most common site of GCP was cardia(51.43%,18/35),and the main endoscopic manifestations of GCP were flat mucosal lesions(68.57%,24/35),mainly 0‑Ⅱa and 0‑Ⅱa+Ⅱc type lesions,accounting for 66.67%(16/24).The second common endoscopic manifestation was polypoid eminence(20.00%,7/35).Endoscopic ultrasonography was performed in 15 patients,with main manifestations of uniform hypoechoic with or without cystic echo(73.33%,11/15).Among the GCP cases,33 patients received endoscopic resection,and 2 received surgical treatment.The treatment processes were all successfully completed,and en‑bloc resection was accomplished for all lesions receiving endoscopy,with the mean endoscopic operation time of 86.13 min.One patient suffered postoperative delayed bleeding after ESD which was stopped by endoscopic hemostasis.Final pathological results showed that the proportion of GCP complicated with neoplastic lesions was 77.14%(27/35),68.57%(24/35)with early gastric cancer or precursor.Twenty‑three cases achieved R0 resection.One case showed positive basal resection margin and vascular invasion,and recurrence happened in situ at the 5th month of follow‑up,surgical resection was then performed.The endoscopic complete resection rate was 95.83%(23/24).Conclusion GCP usually occurs in middle‑aged and elderly male,often located in cardia,manifested mainly as flat mucosal lesions and polypoid changes.Endoscopic ultrasonography shows a high diagnostic value for GCP,and endoscopic treatment is safe and effective minimally invasive treatment for GCP.